RESUMO
The recent release of new oral anticoagulants (NOAC) raises the question of the management of intracranial hemorrhage occurring during treatment with these molecules. Dabigatran, rivaroxaban and apixaban have different pharmacological characteristics that physicians need to know to adjust their prescription to each patient. Studies of efficacy and safety prior to the marketing of these molecules showed a decreased risk of intracranial hemorrhage compared with vitamin K antagonists. However, no reliable data are available regarding the prognosis of these hemorrhages occurring during NOAC treatment. In addition, there is no specific antidote and reversal protocol validated in humans. So, physicians are in a difficult situation when critical bleeding occurs. The timing of recovering normal hemostatic capacity is then a determinant factor of prognosis. Studies in animals or healthy volunteers showed a correction of the biological parameters using prothrombin complex concentrates activated or not, without reducing the volume of hematoma. On this basis, proposals have been issued by the french group of interest for perioperative hemostasis (GIHP) for the management of bleeding under NOAC treatment, which include management of intracranial hemorrhage.
Assuntos
Anticoagulantes/efeitos adversos , Hemorragia Cerebral/induzido quimicamente , Acidente Vascular Cerebral/induzido quimicamente , Anticoagulantes/uso terapêutico , Benzimidazóis/efeitos adversos , Benzimidazóis/uso terapêutico , Hemorragia Cerebral/epidemiologia , Dabigatrana , Humanos , Morfolinas/uso terapêutico , Pirazóis/uso terapêutico , Piridonas/uso terapêutico , Rivaroxabana , Acidente Vascular Cerebral/epidemiologia , Tiofenos/uso terapêutico , beta-Alanina/efeitos adversos , beta-Alanina/análogos & derivados , beta-Alanina/uso terapêuticoRESUMO
Acute glaucoma angle closure is a rare complication of anaesthesia and multimodal analgesia. However it is a medical emergency, hence any delay in its treatment may have catastrophic consequences. We present a case of postoperative glaucoma, which had evolved to permanent blindness. We also reviewed the French pharmacovigilance database between 1996 and 2006 and found four other cases of acute glaucoma angle closure in postoperative period possibly related to the administration of nefopam.
Assuntos
Analgésicos não Narcóticos/efeitos adversos , Cegueira/induzido quimicamente , Nefopam/efeitos adversos , Idoso , Anestesia Geral , Artroplastia do Joelho , Cegueira/fisiopatologia , Feminino , Glaucoma de Ângulo Fechado/induzido quimicamente , Humanos , Bloqueio Nervoso , Doenças do Nervo Óptico/induzido quimicamente , Medição da Dor , Dor Pós-Operatória/complicações , Dor Pós-Operatória/tratamento farmacológico , Complicações Pós-Operatórias/induzido quimicamente , Complicações Pós-Operatórias/fisiopatologiaRESUMO
Accidental dural puncture is a well-recognized complication of obstetric epidurals that can potentially incapacitate the patient. Unrecognized dural puncture during epidural administration can lead to a delay in therapeutic intervention resulting in potentially serious complications. We report a case of a parturient who developed disabling intracranial hypotension and diplopia following accidental dural puncture during apparently uneventful epidural catheter insertion. Magnetic resonance neuroimaging was performed to confirm the diagnosis, and direct clinical management. We also discuss the role of neuroimaging in the investigation of postpartum headache.
